It’s so large, that the U.S. Surgeon General issued a letter to every physician in the United States — 2.3 million to be exact.

What was the concern? Opioid use.

Opioids are highly effective painkillers. This makes them one of the most important classes of drugs we have.

But they are also highly addictive, and they are killing thousands every year from overdose.

In 2014, some 19,000 people died from opioid drugs in the U.S.

2014 is the latest year for which we have full data available, but if the trend over the previous 14 years holds true, the number of people dying from abuse and misuse of opioid drugs will be even higher this year.

Between 2001–2014, the number of opioid-related deaths in the U.S. more than tripled:

Moreover, the health care costs of abuse are now reaching $25 billion in the U.S. alone.

Many of those dying from opioid drugs aren’t who you would necessarily call stereotypical drug abusers.

But opioids and humans have a long history…

We’ve been using opium and its various forms for at least 5,000 years. Poppy seeds and opium extracts have been found in European archaeological digs from the Bronze Age.

Opium contains alkaloids — chemical compounds that can affect human physiology. Two of the most powerful alkaloids in opium are morphine and codeine. Eventually, early pharmacists learned how to separate opium into those constituents.

In 1827, the German pharmaceutical company Merck began marketing morphine, the most powerful direct derivative of opium and the very close chemical cousin of heroin. More than half a million capsules of opium were dispensed in the Union Army during America’s Civil War.

Soldiers called it “God’s own medicine.”

Morphine indeed has been a miracle drug to soldiers in many wars. And to this day, morphine and other similar opium derivatives are the only effective medicines we have for both severe and chronic pain.

Opioids stimulate the brain’s reward circuits, producing feelings of pleasure and well-being. That’s why we like them so much. They can create addiction.

And it can happen to anyone, including you.

The road to addiction and death can start with unmodified prescription drugs, but it gets worse from there.

Some opioid drug users end up reprocessing prescription opioid drugs for recreational use. They modify them for smoking, snorting or injection so that even extended-release formulation can have strongly euphoric short-term effects.

Of course, this also drives up the risk of coma, respiratory arrest and death.

And sometimes, prescription opiates are stolen or otherwise moved out of the health care system to be sold in modified form on the street.

Of course, there are side effects to all medicines, and those associated with opiates are really frightening…

According to the American Society of Addiction Medicine, four of every five heroin addicts began by using prescription drugs.

Opiates are highly addictive — more addictive than any substance known. And yet we really have little else to manage severe pain, pain that is the aftermath of accidents and surgery and that which becomes chronic.

So is it any wonder that we have a serious problem with addiction?

Like I mentioned earlier, in August, the U.S. Surgeon General stepped in, sending a letter to all doctors to beg them to stop overprescribing painkillers. Dr. Vivek Murthy said it would help “solve an urgent health crisis facing America: the opioid epidemic.”

It’s a dire warning.

Estimates vary, but as many as half the American addicts of opiate-based drugs may have learned their addictions in hospitals and from physicians.

The FDA announced a strategy to try to reduce those numbers, at first concentrating on encouraging the drug industry to produce more so-called ADFs, or abuse-deterrent formulations. ADFs are versions of opiates that won’t work as effectively if crushed (so they can be snorted) or dissolved (so they can be injected).

It’s just a baby step toward trying to deal with opiate addiction, and the FDA knows it.

That said, the FDA will welcome alternative painkillers with open arms.

Drug companies who can produce a painkiller that’s abuse-resistant, and less likely to contribute to the growing opioid crisis, are bound to succeed.

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